Pregnancy food guide: Truth about what you can eat (+ cheat sheet)

Our guide to what’s safe, what to avoid and what’s essential to eat during pregnancy.

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Pregnancy comes with a lot of confusing dos and don’ts—especially when it comes to food. Suddenly, you’re anxiously reading labels and googling ingredients at the grocery store and at restaurants. Does this fish contain too much mercury? How much coffee can I have—or should I just switch to decaf? Is all pasteurized cheese safe? While some pregnancy food rules are cut and dry, others aren’t, and all this advice—and sometimes-conflicting information—can really depend on who you ask.

Recently, medical experts have noticed that some pregnant women have become overcautious when it comes to fish, steering clear of one of the foods they might need the most. Expectant mothers have long been cautioned about fetal exposure to mercury in fish. But after a US Food and Drug Administration (FDA) analysis of 1,000 pregnant women showed that 21 percent had not eaten fish at all in the previous month, the FDA released a draft of updated guidelines in June to encourage women who are trying to conceive, are pregnant or are breastfeeding to eat more fish—between eight and 12 ounces (226 to 340 grams) per week. (That’s about two to three servings.) Health Canada simply recommends all women who could become pregnant, are pregnant or are breastfeeding consume a minimum of 150 grams, or two servings, of cooked fish per week.

While methylmercury (the form present in fish) is toxic to the central nervous system of the fetus, fish low in mercury are perfectly safe to eat during pregnancy, says Lianne Phillipson-Webb, a Toronto–based nutritionist, author and owner of Sprout Right, which specializes in prenatal and family nutrition. In fact, it’s really important to keep eating fish. Fatty fish—like herring, mackerel, salmon, sardines and trout—offer the best source of omega-3 fatty acids (particularly DHA and EPA), which are particularly beneficial for the fetus. “They help to feed and boost both the neurological and early visual development of the baby,” adds Phillipson-Webb. During these nine months, avoid fish higher in mercury, says Health Canada spokesperson Leslie Meerburg, such as fresh or frozen tuna, shark, swordfish, marlin, orange roughy and escolar. Typically, the bigger the fish, the higher up on the food chain it is and the higher the mercury content. (Big fish eat little fish, and the mercury content builds up in their bodies.)

Pregnant women also need to be very cautious of food-borne illnesses, and there are numerous sources: raw or undercooked seafood, raw meats and eggs, non-dried deli meats, undercooked hot dogs, refrigerated pâtés and meat spreads, raw sprouts, soft and semi-soft cheeses, unpasteurized juice and cider, unpasteurized honey and unwashed raw fruit and vegetables.

Food-borne illnesses can be more dangerous when you’re pregnant, because the immune system has to down regulate in order to host the fetus, says Phillipson-Webb. If pregnant women are exposed to the listeria bacteria, they are 20 times more likely than other healthy adults to develop listeriosis. Heather Lovelace, a registered dietitian who sets the nutritional practice standards for care of women and children at BC Women’s Hospital and BC Children’s Hospital in Vancouver, notes that even if the mother’s symptoms are mild, some food-borne illnesses can cross the placenta and infect the baby. The onset of mild listeriosis, for example, can happen about three days after exposure, or, for the more serious version of the illness, up to 70 days after. (The symptoms are flu-like: fever, headache, nausea, vomiting and diarrhea.) This can lead to a miscarriage in the first trimester, stillbirth or a sick newborn.

Protecting yourself and your baby often means a few tweaks to your routines. Wash all fruit and vegetables well, even if they are organic. (Phillipson-Webb recommends using a veggie wash, not just rinsing with water.) Meats, eggs, seafood, hot dogs and sprouts need to be thoroughly cooked (that means no medium-rare steak or sunny-side up eggs). Love sushi? You can switch to vegetarian or cooked seafood options, such as a California roll, unagi (eel) roll or shrimp nigiri (but skip the spicy tuna and salmon rolls). And if you’re suddenly craving a turkey melt, just heat the deli meat to steaming hot throughout. Honey is fine if it’s pasteurized, but pass on refrigerated smoked salmon, pâtés, meat spreads (unless canned), and unpasteurized juice and cider.

Cheeses are a bit—OK, a lot—more complicated. All milk sold in Canada must be pasteurized and is therefore safe, while cheeses made from raw or unpasteurized milk are available and should be avoided. But even soft and semi-soft cheeses made with pasteurized milk (e.g., brie, Camembert) are considered a risk for listeriosis, notes Lovelace. “Listeria can grow at refrigerator and even freezer temperatures,” she explains. Soft and semi-soft cheeses are higher in moisture and lower in salt and acids, so the bacteria could grow and cause illness if the cheese is contaminated after pasteurization. “While Canada has strong procedures and monitoring to avoid bacterial contamination during food production, the risk is minimized, but not eliminated,” she says. Processed soft cheeses, such as cottage cheese and cream cheese, are safe because they are packaged immediately. While pregnancy websites like BabyCenter.ca and Motherisk.org state that pasteurized, shelf-stable packaged products such as feta, mozzarella and tubs of ricotta are fine to consume, Health Canada errs on the side of caution and recommends avoiding them. (They’re lower risk than brie and Camembert, but there’s still some risk of listeriosis.)

Coffee is another concern for many expectant moms. Caffeine has been linked to low birth weights, so Health Canada recommends pregnant women consume no more than 300 mg daily. (This may not be a problem if you suffer from morning sickness; many women don’t want coffee when they’re feeling nauseated.) “Caffeine will cross the placenta into the baby and have a stimulating effect,” says Phillipson-Webb. But it’s important to note that not all coffee is caffeinated equally. “The caffeine content varies by type of coffee and method of preparation,” says Lovelace, adding that drip coffee contains the most (typically 140 to 240 mg of caffeine per eight ounces, or 240 mL), followed by brewed coffee, and then instant. As a general rule, expectant mothers can have two small cups of brewed coffee each day. But be aware of other sources of caffeine, like pop and chocolate, and the size of the cup—some mugs hold the equivalent of two cups of coffee. (A Starbucks grande brewed coffee, for example, which holds 16 oz. or 473 mL, is already 330 mg of caffeine—over the daily max.) Decaf can help satisfy those cravings after you’ve hit your daily limit.

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The recommendations about drinking during pregnancy vary by country and culture. In the UK, moms-to-be are advised to have less than one to two drinks a week, only after the first trimester, and to never get drunk. In Canada, the official medical stance is that no alcohol is safe to drink during pregnancy, and there’s no safe time or trimester to imbibe. (It’s hard to conduct an ethical study in humans to determine how much drinking causes fetal alcohol spectrum disorder, or at what point of pregnancy drinking causes FASD.) While some women are comfortable having the odd glass of wine, as is often accepted in Europe, experts in Canada say no amount of booze is safe.

As you prepare to welcome your wee one into the world, chances are you’re going to accidentally eat something considered questionable or unsafe. Don’t agonize—just relax, learn from it and be smart going forward.

Indulging in ice cream?
While pregnant women should avoid homemade ice cream (because it might contain raw eggs, and the risk of salmonella contamination), store-bought ice cream is generally safe. You may have read about a few listeriosis outbreaks linked to improperly sanitized soft-serve machines, but the risk is extremely low, and it doesn’t mean you have to avoid this common pregnancy craving altogether. (In the last decade there have also been listeria outbreaks traced to celery, cabbage and cantaloupe! It’s impossible to avoid all risk.)

A version of this article appeared in our August 2014 issue with the headline “The truth about what you can eat during pregnancy,” pp. 26-8.

Read more:
Get your fix: 6 caffeine alternatives>
The pregnancy diet: 5 must-have foods>
The debate: Did you drink at all while pregnant?>

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